What does it mean for a health plan to be 'audit-ready'?

Being 'audit-ready' means that a health plan has organized, accurate, and complete clinical documentation. This is crucial because it ensures that all the necessary information is available and easily accessible for review during an audit. Accurate clinical documentation underpins the validity of the data submitted to risk adjustment programs and demonstrates compliance with regulatory requirements.

When a health plan is well-prepared for an audit, it not only reflects the integrity of its clinical processes but also underscores its commitment to maintaining high standards in patient care and reporting. This comprehensive documentation facilitates a smoother audit process, helping to substantiate claims and validate the appropriateness of risk adjustment coding and reimbursements, ultimately leading to better financial outcomes and compliance with Centers for Medicare & Medicaid Services (CMS) standards.

While the other options mention important aspects of operations and compliance, they do not encapsulate the essence of being audit-ready as thoroughly as the accuracy and completeness of clinical documentation do.